调和气血法治疗脊髓型颈椎病的双向队列研究

Ambispective Cohort Study on Treatment of Cervical Spondylotic Myelopathy with Qi-blood Regulation Method

目的：观察脊髓型颈椎病的自然史和演变过程，探索其发病发展规律，从而进一步提高对脊髓型颈椎病的认识，为中医药治疗提供理论基础。方法：收集上海中医药大学附属龙华医院施杞教授特需和专家门诊（1998年3月～2007年7月）接受调和气血法中药治疗的、随访2个月以上、资料完整的80例脊髓型颈椎病患者，设计相关量表，通过返院门诊复查、电话询问、信函调查等方式再次进行随访，观察上述病例目前的临床症状及各类评分的变化，对量表的结果用SPSS软件数据统计处理，并作出客观评价。结果：（1）初诊与第一次随访时的40分评分和JOA评分总分比较，差异有统计学意义（P〈0．05），提示本组患者经过调和气血法中医治疗后，脊髓功能评分较前提高。（2）继续长期坚持调和气血法中医治疗的患者，第一次随访和第二次的40分评分和JOA评分总分比较，差异有统计学意义（P〈0．05），提示本组患者经过长期调和气血法中医治疗，脊髓功能评分较前提高。该组患者初诊和第一次随访的40分评分、JOA评分总分差值与第一次和第二次随访的差值比较，差异无统计学意义，提示脊髓功能评分第一次随访时的缓解程度和第二次随访时无明显差异。（3）未能坚持继续调和气血法中医治疗的患者，不论第一次随访脊髓功能评分是否满分，其第一次和第二次随访的40分评分和JOA评分总分比较，差异有统计学意义，提示未坚持继续调和气血法治疗的患者，其病情较前加重。结论：调和气血法中医治疗脊髓型颈椎病，近期及远期均具有明显疗效，且疗效稳定。坚持长期调和气血法中医治疗，不仅能预防病情的反复，而且促使病情的进一步缓解。

This study was aimed to observe the natural history and evolution of cervical spondylotic myelopa- thy, explore development law of the disease incidence in order to improve the understanding of cervical spondylotic myelopathy and provide a theoretical basis for Chinese medicine treatment. Complete clinical data of 80 cervical spondylotic myelopathy cases were collected from March 1998 to July 2007 in special and ex- pert practice of Prof. Shi＇s out-patient department. Chinese medicine for qi-blood regulation was given in the treatment. Related measuring scales were designed. More than of returning visit, telephone calls and letter inquiries. Change two-month follow-up was given through means s of clinical symptoms, and scores of different types of evaluations were observed. The SPSS software was used in the data analysis of results from measuring scales for the objective evaluation. The results showed that there were statistical differences on the 40-score and JOA total score between initial visiting and first time follow-up （P 〈 0.05）. It suggested that through Chinese medicine qi-blood regulation treatment, the scores on spinal cord function were increased compared with the previous visiting. For patients who continued long-term Chinese medicine qi-blood regulation treat- ment, there were statistical differences on the 40-score and JOA total score between the first-time follow-up and second-time follow-up （P 〈 0.05）. It suggested that through continued long-term Chinese medicine qi- blood regulation treatment, the scores on spinal cord function were increased compared with the previous visit- ing. In this group of patients, there were no statistical differences on the 40-score and JOA total score be- tween the patient＇s initial visiting, first time follow-up, and the first-time follow-up and second-time follow- up. The scores on spinal cord function suggested that there was no obvious difference on the relieving degree between the first-time follow-up and second-time follow-up. For patients who were unable to continue the Chinese medicine qi-blood regulation treatment, no matter if it was full score on the spinal cord function in the first-time follow-up, there were statistical differences on the 40-score and JOA total score between the first-time and second-time follow-up. It suggested that the disease became worse when patients were unable to continue the Chinese medicine qi-blood regulation treatment. It was concluded that Chinese medicine qi- blood regulation treatment for cervical spondylotic myelopathy has a significant effect in both short-term and long-term treatment with steady effectiveness. Patients who continue the Chinese medicine qi-blood regulation treatment not only can prevent disease recurrence, but also can promote further relieving of disease condition.